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APPLICATIO.� FOR CONSTRUCT�JN PERMIT�}�. <br /> CITY OF EVERETT•BUILDING DIVISION �/'�� <br /> 3200 C[DAR STREET•EVERETT,WA 98201 •259•BB10 ���' <br /> O DEMOLITION p COMBINATION Iv� BUILDING ❑ MECHANICAL O PLUMBINd ❑ SIGN <br /> PROJECTAODRESS: ��I.?�1 C-L.�s+n�t <br /> �uST RtTf_ G�gois Q��v�v t�i�J e„�rct� �5.�01 a4o -lSI� _ <br /> OWNER MMIMONE55 CIfV I��' P�qNE <br /> 1EN/JIf YMLRIDRf55 CIIY lIP PIIONE <br /> MILIEICG�ORDESi0Nf11 MMl!ODRE55 LIfY lil` PNONF <br /> SAmc �� �h�ve _ <br /> 6EMOAlCONfMGTOf1 M11l�ODRE55 f.�lY liP PI10NE SI�IEI�CFNSE• <br /> MECHANICA�'tONTMGTqi MIJI�UDRE55 f.IIY 71P PIIONE Si�TEIICENSE� <br /> AUMlINOCONtR�GTOR N�IIADDRE55 Clfv 21P PIIOHE STAtELICENSE� <br /> GONTMCT P11ICE Oi NOfllt <br /> ���a�� SS��w Gu ,��f�(,�-c� Gj HEATING SYSTEM: C"]GAS ❑ ELECTRIC O_ <br /> OESLPolE WOIIN�NO 60U�pE i00T/�OE W VOIVED CONf�tT i'C�Sp1.410 P110NE 1A <br /> � � /�.8N.�0� <br /> 1 I HEREBV CERTIFY THAT I HAVE READ ANO EXAMINED THIS <br /> APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT ALL <br /> rnao o use or euia PROVISIONS OF LAWS ANO ORDINANCES 60VERNING THIS'VPE OF <br /> WORK WILL BE COMPLIED WITH WHETHEfl SPECIFIED HEREIN OR <br /> lEOK0E5CPoPTI0N0i01101'E11tV�51qWNeEIOwOR��7�CNTYIOCOVIES� N01. THE ORANiINO OF A PERMIT DOES NOT PRESUME TO 61VE <br /> �or�_eiocK or � � —�� AUTHORITY TO VIOLATE OR CANCEL THE PRJVISION OF ANY <br /> OTNER STATE OR LOCAL LAW RE6ULATINO CONS7RUCTION OR THE <br /> PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORI2ED BY TI�E <br /> — OWNER OF THIS PHOPERTY TO PERFORM THE WORK FOR WHICH <br /> APPLICATION IS MAOE AND I COMPLY WITH THE STATE <br /> FMCELTl1k IA.MMECR CONTRACT RS AW 1B27 PCW AND 298.200 WAC. <br /> CON IIIUCTION LONI LENDER. E S.TEIFi'110NE NU4lF.R % e <br /> 5b ���z-��,w o��� 7-9G <br /> cirv eus��ss i�ceNsc rro <br /> PLUMetNO MECHANICAL <br /> NO. TYPE OF fl1(TURE OR ITEM FEE NO. TYPE OF EOUIPMENT FEE <br /> WATERCLOSEi(TOILEn � A/C—MHNDLOUNRS ' <br /> BATHTUB ; � FORCEDAIRSYSTEMS ' <br /> LFVATORY(WASH BASIN) � HEAT PUMP i <br /> SHOWER ' UNIT HEATERS ' <br /> KITCHEN SINK 8 DISP i CLOTHES DRVERS i <br /> DISHWASHER � � FINGEH000 � <br /> UUNDRY TRAV � / WATER HEATER � <br /> CLOTHES WASHER � WOOU STOVE � <br /> URINAL � MEfAL FIREPLACE(1NOOD BURNING) ' <br /> ORINKINA FOUNTAIN i FIREPLACE INSEFiT QNOOD BURNING) i <br /> FLOOR DRAIN � GAS FIREPLACE � <br /> BACKFLOW PREVENTERS ; GASRANGE ; <br /> SINK(SEHVICE—BAR.ETC.) � a GAS PIPINO � <br /> � '� EXHAUST FAN <br /> � � <br /> � � <br /> SUB TOTAL f , SUB TOTAL S _T_ <br /> PERMIT S � PERMIT f � <br /> TOTALFEE f � TOTALfEE S ' <br /> FOR OFFICE USE ONLY: <br /> iRONTSFTBACR PEMSETB� R . � SIDESFTB�Ck / PUNCUECItNUMP f1 fEf AEf.E1PIN0 <br /> � � ,r�� 53,�i� 3�� �a7 <br /> USEIONF �A �orenE� � ��CAHI5IIE FEES V�LUIITION FEE T_ <br /> G� ❑res O rw mmrnHn S'�! 7 '�� t�� <br /> .�f � � <br /> NE�OHT UMIUiION NO O'D ELUNO SRE Oi B100R1 � <br /> � UNIIR OZ � 1`�II4pIN6 /4oJ <br /> OCCUPINCY Iq d SIMFS OGCIIPANI 10�0 BA MENT � <br /> OROIN � � MECII�HIC�I � i�C� <br /> ❑YES 9M0 � <br /> FIR SPRINKIE REO'0 �f�5pl �OO���ONMI`IANp�fCN _�—_• <br /> i <br /> plPCfl � <br /> iIBENMMRE 'D pF�50M <br /> ' Si�IFOUII��NOSII�CIIMIOE —_ i C.- i <br /> �yl�.0 <br /> trvear,oNs� rinNsenrnov¢oev� CITVOFEVERETT runiicwones _ _ _a> � ,7c� <br /> LOCAL SALES —"�— <br /> ��_ DAfE I TAx CODE IS 3105 TOi�L 'i,-J "� �,> <br />